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Image Challenge

A 63-year-old man presented with generalized bone pain for one year. He had hepatitis B and took adefovir dipivoxil over 6 years. Laboratory data showed hypophosphatemia, moderate renal impairment, high alkaline phosphatase level, aminoaciduria and normoglycemic glucosuria. 99mTc-MDP bone scintigraphy showed diffused increased uptake (Fig1a). The CT scan of the sacroiliac joints showed blurred bilateral articular surfaces and a right iliac fracture (Fig1b).

What is the most probable bone disease of the case?
A. Multiple myeloma
B. Hypophosphatemic osteomalacosis
C. Malignant tumor with bone metastases
D. Osteitis fibrosa cystic
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